Differential Diagnosis for 3 Month Old with Dark Colored Stools and Frequent Feeding

• Single Most Likely Diagnosis
  • Gastroesophageal Reflux Disease (GERD): This condition is common in infants and can cause dark-colored stools due to swallowed blood from esophageal irritation. Frequent feeding can exacerbate reflux symptoms.
• Other Likely Diagnoses
  • Cow's Milk Protein Allergy or Intolerance: This can lead to gastrointestinal bleeding, resulting in dark stools, and may cause feeding difficulties or frequent feeding due to discomfort.
  • Foremilk Hindmilk Imbalance: An imbalance in the foremilk and hindmilk during breastfeeding can cause gastrointestinal upset, leading to dark stools and frequent feeding.
  • Overfeeding or Underfeeding: Both can lead to gastrointestinal symptoms, including changes in stool color and feeding frequency.
• Do Not Miss Diagnoses
  • Intussusception: Although less common, this condition can cause dark, "currant jelly" stools due to intestinal bleeding and may lead to feeding difficulties or refusal.
  • Volvulus or Other Intestinal Obstructions: These are emergencies that can cause vomiting, abdominal distension, and changes in stool, including dark color.
  • Infectious Gastroenteritis: Certain infections can cause gastrointestinal bleeding and changes in stool appearance, along with increased feeding frequency due to dehydration.
• Rare Diagnoses
  • Hirschsprung's Disease: A congenital condition affecting the colon, leading to severe constipation or obstipation, but can sometimes present with enterocolitis and dark stools.
  • Congenital Infections (e.g., CMV): Can cause gastrointestinal symptoms, including changes in stool, in newborns.
  • Allergic Proctocolitis: An allergic reaction to cow's milk protein passed through breast milk, leading to rectal bleeding and potentially dark stools.